RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	     CASE:  PD-2014-02409
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20061105 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Infantryman) medically separated for a right rotator cuff tear.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty; but was authorized (per profile) alternate aerobic events to satisfy physical fitness standards.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The “right rotator cuff tear” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “right shoulder pain with right rotator cuff tear” as unfitting, rated 20%, citing application of the application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI requested that the Board review all of his conditions.  His complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:  

IPEB – Dated 20060927	VA* -  ~7 Months Post-Separation	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain with Right Rotator Cuff Tear	5099-5003	20%	Right Shoulder Rotator Cuff Tear	5201	30%	20070612	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 4	
RATING:  20%	COMBINED RATING:  40% 	
*Derived from VA Rating Decision (VARD) dated 20070828 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:   

Right Shoulder Pain with Right Rotator Cuff Tear.  The record showed that the CI had a traumatic injury to his right shoulder while deployed in 2003.  The CI had rehabilitation and was able to return to duty until re-injury.  He subsequently underwent surgery on 10 September 2004 to repair the rotator cuff and the shoulder cartilage with a revision on 7 March 2005, the latter complicated by a post-operative infection which required wash out.  At a follow up on 1 April 2005, he was noted to have full active range-of-motion (ROM).  A week later flexion was measured at 150 degrees (180 degrees is normal).  A week after that, both flexion and abduction (away from the body) were painful with flexion limited to 110 degrees and passive abduction normal.  Flexion was again 150 degrees on 27 April 2005.  The CI continued rehabilitation, but reinjured himself lifting a litter on 17 August 2005.  X-rays on 13 October 2005 and an MRI on 30 November 2005 showed post-operative changes.  A subsequent MRI on 10 February 2006 showed changes consistent with a small tear of the supraspinatus tendon which is part of the rotator cuff.  In physical therapy (PT) on 3 April 2006, the ROM was noted to be 170 degrees for flexion and 160 degrees for abduction, both painful above 90 degrees.  Strength was reduced at 4/5 with generalized tenderness.  At a physical medicine appointment on 10 April 2006, the passive ROM was noted to be full, but the active ROM painful in all planes.  Strength was normal other than flexion and rotation which were reduced.  No discrete atrophy was present.  Signs of rotator cuff irritation and impingement were present, but no signs of instability were documented.  An orthopedic examination 3 days later documented no weakness of the shoulder and no atrophy.  Formal ROM measurements were obtained in PT on 10 July 2006, less than 4 months prior to separation, and are charted below.  At the MEB examination on 17 July 2006, reduced strength at 4/5 with pain was noted and reduced ROM.  The narrative summary was dated 7 September 2006, 2 months prior to separation.  It noted that the CI continued to have pain despite rehabilitation after the re-injury in August 2005 and that further surgery would offer no benefit for his pain.  The CI was referred to MEB to prevent further injury.  On examination, his strength was reduced secondary to pain.  

At the VA Compensation and Pension (C&P) examination performed on 12 June 2007, 7 months after separation, the CI reported continued and progressive pain with fair control from a home exercise program.  He stated that he was not employed.  On examination, the ROM was limited as below and recorded as further limited with repetition, but the actual ROM documented did not change.  The examiner noted guarding of the shoulder, but did not record strength or stability.  A post separation C&P examination on 18 November 2010 noted that the CI was self-employed in construction after separation until he quit in 2007 secondary to problems with both knees and both shoulders.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Right Shoulder ROM
(Degrees)	MEB ~3 Mo. Pre-Sep	VA C&P ~7 Mo. Post-Sep	
Flexion (180 Normal)	120	90	
Abduction (180)	110	90	
Comments	No additional comments	Pain with repetition	
§4.71a Rating	10% w 4.59	20% (VA awarded 30%)	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB cited the pain policy and rated the right shoulder at 20% using the code 5099-5003 (analogous to degenerative arthritis).  The VA used the 5201 code (limitation in motion), but rated the right shoulder at 30% noting that the shoulder was limited to midway between the side and shoulder level.  It was actually limited at the shoulder level both before and after repetition.  The Board considered the evidence.  The VA ROM values support a 20% rating.  The PEB measurements support a 0% rating using the 5201 code and a 10% rating for painful motion using the 5003 code in accordance with VASRD §4.59.  The PEB measurements were consistent with multiple prior measurements and are also more proximate to separation.  It is therefore accorded higher probative value for rating purposes and supports a 10% rating.  However, the PEB does not recommend a rating lower than that adjudicated by the PEB.  The Board noted that 5201 provides a better description of the disability, but provided no rating advantage to the CI.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the right shoulder condition.  

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  As discussed above, PEB reliance on the USAPDA pain policy for rating the right shoulder was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the right shoulder pain condition with right rotator cuff tear condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140516, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX, AR20150019017 (PD201402409)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA